Differential Diagnosis for a 20-year-old Woman with History of Binge Eating, Overuse of Laxatives, and Periods of Starvation

• Single Most Likely Diagnosis
  • Bulimia Nervosa: This condition is characterized by recurrent episodes of binge eating followed by compensatory behaviors such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise. The patient's history of binge eating, overuse of laxatives, and periods of starvation aligns closely with the diagnostic criteria for bulimia nervosa.
• Other Likely Diagnoses
  • Anorexia Nervosa, Binge-Eating/Purging Type: While anorexia nervosa is primarily associated with restrictive eating, the binge-eating/purging type involves episodes of binge eating or purging behaviors, including laxative abuse. The periods of starvation could indicate an attempt to compensate for binge eating episodes.
  • Eating Disorder Not Otherwise Specified (ED-NOS): This diagnosis is considered when an individual's eating disorder symptoms do not meet the full criteria for anorexia nervosa, bulimia nervosa, or another specific eating disorder. Given the combination of binge eating, laxative use, and starvation, ED-NOS could be a possibility if the symptoms do not fully align with bulimia nervosa or anorexia nervosa.
• Do Not Miss Diagnoses
  • Electrolyte Imbalance and Dehydration: The overuse of laxatives can lead to severe electrolyte imbalances (e.g., hypokalemia, hypocalcemia) and dehydration, which are potentially life-threatening conditions requiring immediate medical attention.
  • Gastric Rupture: Although rare, prolonged and severe vomiting or laxative abuse can lead to gastric rupture, a medical emergency.
  • Osteoporosis: Malnutrition and starvation can lead to osteoporosis, increasing the risk of fractures. Early detection and treatment are crucial to prevent long-term bone health issues.
• Rare Diagnoses
  • Pica: Characterized by eating non-food substances, pica can sometimes be associated with eating disorders and malnutrition. It's less likely but should be considered, especially if there are hints of eating non-food items.
  • Rumination Disorder: Involves the repeated regurgitation of food, which may be re-chewed, re-swallowed, or spat out. While not directly related to laxative use, it's a rare eating disorder that could co-occur with other eating disturbances.
  • Avoidant/Restrictive Food Intake Disorder (ARFID): Although primarily associated with a lack of interest in eating or a fear of eating due to concerns over the taste, texture, or nutritional content of food, in rare cases, it could present with significant weight loss or nutritional deficiency, similar to what might be seen in starvation periods.